Children’s Foster Care Clinic Bridges Gap in Care

Every year, thousands of children in Nebraska, lugging the weight of what they’ve seen and what they’ve experienced, are forced to walk through that dark tangle of statistics:

More than 63 percent of children in foster care were removed from the home because of parental neglect, an all-too-often byproduct of drug use, violence in the home or a parent’s mental health. (State of Nebraska Foster Care Review Office (NFCRO), 2017-2018 annual report)

Nearly 40 percent of children reviewed by the NFCRO had a mental health diagnosis at the time of review.

According to the American Academy of Pediatrics (AAP), approximately 50 percent of children entering foster care have chronic physical problems, 10 percent are medically fragile or complex, and many were exposed to substances before birth.

A daunting walk—but they do not walk alone.

“Seeing these kids survive and thrive despite all of this adversity is amazing,” says Suzanne Haney, M.D., division chief, Child Advocacy Team, at Children’s Hospital & Medical Center, and currently the only board-certified child abuse pediatrician in Nebraska.

She envisioned and leads Children’s Foster Care Clinic, an outreach program launched to amplify Children’s efforts to support Omaha-area children in foster care. It is the only one of its kind in the region. In a single visit, the clinic’s multi-disciplinary team provides complete physical examinations, psychosocial assessments, developmental screenings, dental assessments and fluoride treatments, visual evaluations and nutritional evaluations.

“We identified a gap that we thought was important to fill in the continuum of care,” says Steven Burnham, senior vice president of Physician Networks, and president of Children’s Physicians and Children’s Specialty Physicians.

Upon entering foster care, children in the Omaha area are typically and initially screened at Project Harmony, an advocacy center for children who have been abused or neglected. Prior to opening the Foster Care Clinic, “what we found was—after they left Project Harmony—part of the time they wouldn’t get their prescriptions, part of the time they would never go back and see their primary physicians, and that screening information rarely got to the foster parents. So, children were just kind of getting lost,” says Dr. Haney, who also serves as Project Harmony’s medical director

Now, after that initial exam, Project Harmony refers children to the Foster Care Clinic for those more comprehensive assessments, the results of which are shared with the birth family, foster family, caseworkers and primary care provider.

“Children in foster care are considered by the AAP as children with special health care needs. Not meeting those needs is a travesty,” Dr. Haney says. “Abuse and neglect cause trauma to children. As a result, they have a risk of some significant long-term issues, including everything from heart disease to diabetes. Failure to thrive or malnutrition is a very common thing we see. These are kids who are at much greater risk for long-term complications.”

Children are seen about six weeks into their foster care placement, which gives foster parents a chance to identify concerns and the clinic case manager a chance to obtain all of the child’s medical records. While the visit can last as long as four hours, Dr. Haney says “most foster parents do appreciate getting it done in one shot.” Afterward, a follow-up appointment is scheduled with the child’s primary care provider.

“Our goal is to assess each child, develop a plan and then transfer them to their primary physician for ongoing care,” explains Dr. Haney. “It really is a partnership with the general pediatricians in the area.”

Dr. Haney says the clinic is designed to help meet the medical and behavioral health needs of children placed in foster care, but the ultimate goal is broader than that—it’s about helping these kids grow into successful members of society.

“These children getting their medical and especially their mental health needs met sooner means they have a better chance of succeeding,” Dr. Haney says. “When the parents are aware of what’s going on, we can start to educate them—these behaviors are expected, here’s how to react to them. I think we can reduce the number of placement changes for the child, and in the long run, get them more quickly to a permanent home.”